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Behavioral Health Benefits

You do not need a referral for your first behavioral health or substance use disorder assessment completed in a 12-month period.

  • Find a list of our behavioral health providers in our online provider directory.
  • Ask your PCP or call Member Services at 1-855-375-8811 (TTY 1-866-209-6421) for a list of mental health providers (who serve adults and children) and substance use disorder providers.

Behavioral health services (mental health and substance use disorder services)

Behavioral health care includes mental health (your emotional, psychological and social well-being) and substance (alcohol and drugs) use disorder treatment and rehabilitation services. All members have access to services to help with mental health issues like depression or anxiety, or to help with alcohol or other substance use disorders. These services require preauthorization and include:

Mental health services

  • Services to help figure out if you have a mental health need (diagnostic assessment services)
  • Individual, group and family therapy
  • Mobile crisis management services
  • Facility-based crisis programs
  • Specialized behavioral health services for children with autism spectrum disorder
  • Outpatient behavioral health services
  • Outpatient behavioral health emergency department services
  • Inpatient behavioral health services
  • Research-based intensive behavioral health treatment
  • Partial hospitalization

Substance use disorder services

  • Outpatient opioid treatment
  • Substance Abuse Comprehensive Outpatient Treatment program (SACOT)
  • Ambulatory detox
  • Non-hospital medical detox
  • Alcohol and drug use treatment center detox crisis stabilization

If you believe you need access to more intensive behavioral health services, like psychiatric residential treatment facilities or assertive community treatment, that your plan does not provide, talk with your PCP or call Member Services at  1-855-375-8811 (TTY 1-866-209-6421).

Also, SACOT and Substance Abuse Intensive Outpatient Program (SAIOP) were made Tailored Plan only by most recent legislation:

Medicaid behavioral health services excluded from the Health Plan benefit. These services are only available in NC Medicaid Direct:

  • Residential treatment facility services for children and adolescents
  • Child and adolescent day treatment services
  • Intensive in-home services
  • Multi-systemic therapy services 
  • Psychiatric residential treatment facilities 
  • Assertive community treatment (ACT) 
  • Community support team 
  • Psychosocial rehabilitation 
  • Substance abuse non-medical community residential treatment 
  • Substance abuse medically monitored residential treatment 
  • Substance Abuse Intensive Outpatient Program (SAIOP) 
  • Substance Abuse Comprehensive Outpatient Treatment (SACOT) 
  • Intermediate care facilities for individuals with intellectual disabilities (ICF/IID) ͞ Innovations Waiver services* 
  • Traumatic Brain Injury Waiver services* 
  • 1915(b)(3) services 
  • State-Funded Behavioral Health and Intellectual and Developmental Disability Services

*Please note that Waiver services are only available to individuals enrolled in the waiver

1915(b)(3) Services:

  • Respite 
  • Supported employment/employment specialist
  • Personal Care/Individual Support
  • One-time transitional costs
  • NC Innovations Waiver Services (funded by [b][3])
  • Community guide
  • In-home skill building
  • Transitional living skills
  • Intensive recovery support

Opioid Misuse Prevention program

Opioids are powerful prescription medicines that can be the right choice for treating severe pain. However, opioids may also have serious side effects, such as addiction and overdose. AmeriHealth Caritas North Carolina supports safe and appropriate opioid use through our Opioid Misuse Prevention program. If you have any questions about our program, call Member Services at 1-855-375-8811 (TTY 1-866-209-6421).